The prostate is a gland just below the urinary bladder of man. It surrounds the urethra and is in front of the rectum. The urethra is the tube that carries urine out of the bladder through the penis and out of the body. What causes prostatitis? There are two types of prostatitis: acute prostatitis and chronic bacterial prostatitis. Both are caused by an infection of the prostate. Some types of prostatitis can be the result of the muscles of the pelvis or the bladder not working properly. What is prostatitis treated? The treatment is based on the cause. Your doctor may do a rectal exam and test urine samples to determine the cause. During a rectal exam, your doctor may examine your prostate by putting a gloved, lubricated finger into the rectum to feel the back of your prostate gland. Antibiotics are used to treat prostatitis that is caused by an infection. You may have to take antibiotics for several weeks or a few months. If prostatitis is severe, you might have to go to hospital for treatment with fluids and antibiotics

What if my prostatitis is not caused by infection? As far doctors do not understand what causes prostatitis without infection, it can be difficult to treat. Your doctor might try an antibiotic to treat an infection that can not be detected. Other treatments are aimed at making you feel better. Nonsteroidal antiinflammatory drugs such as ibuprofen (two brand names: Advil, Motrin) or naproxen (brand name: Aleve) and baths in hot water may help you feel better. Some men are taking medicines that help improve the functioning of the bladder or prostate gland. Can prostatitis be passed on during sex? Sometimes a sexually transmitted organism such as chlamydia cause prostatitis. However, most cases of prostatitis are caused by infections that are not sexually transmitted. These infections can not be transmitted to sexual partners. Can prostatitis back? Men who have had prostatitis once are more likely to get back to giving back. Antibiotics can not reach to spread within the prostate gland well. Small amounts of bacteria can "hide" in the prostate and not be killed by antibiotics. Once you stop taking the antibiotic, the infection can get bad again. If this happens, you might have to take antibiotics for a long period of time from me to prevent another infection. Prostatitis is not caused by an infection is often chronic.

      



MORE GIRLS...? >>>>

After a few years in the market, and their emergence has led to prejudice and false beliefs, which were eliminated. In the early stages of research and clinical use, has proven highly effective with few side effects. Today, sildenafil citrate, known as Viagra has become one of the most used drugs, and that in recent years, its worldwide sales rose a dizzying manner. Commotion by the appearance of the famous pill, which was originally developed Viagra (sildenafil citrate) as a treatment for heart problems. However, later studies showed that this pill also increased blood flow to the penis, so quickly was considered effective for the treatment of erectile dysfunction (impotence). Viagra was approved by the Agency of food and medicine in the United States in 1998. Since then it has become popular, and today is available in over 90 countries.  Has proven effective in treating impotence.

This may be caused by aging, vascular disease, diabetes, prostate operations, spinal cord injuries and even have psychological origins. Sildenafil, which is marketed under the name Viagra, favors the increase of blood supply to the penis, causing erection. But this drug only works when the man is sexually aroused. Despite the upheaval that brought the advent of Viagra, in the medical, media and popular at first sales were not expected and the acceptance by the patients was with some trepidation and reluctance. However, sildenafil is a drug, both in the stages of research and in clinical use, has proven highly effective with few side effects. It is important to note that this is a drug for a specific medical and psychological condition: erectile dysfunction. Although there are people who use it to improve sexual performance, and is even being considered for use in women.

During the urology, specialists from the Institute conducted a complete and thorough physical examination, since it is an essential component of the evaluation of patients with urological diseases. Although for many overworked doctors is tempting to rely on laboratory tests and diagnostic imaging, physical examination often simplifies the process and allows the urologist to select the most appropriate diagnostic studies. The examination is performed on a stretcher, in a quiet, comfortable and private.  'Exploration urological'

Visual inspection. Visual inspection provides the urologist an overview of the appearance of the patient, serves to assess the pallor of anemia or the yellowing of jaundice, it can assess the patient's nutritional status. Cachexia (emaciation) is a common sign of a tumor disease, obesity may reflect endocrine abnormalities. Gynecomastia (enlarged nipple in males), may reflect an alcoholic habit or prior endocrine treatment for prostate cancer. The lower limb edema may reflect the existence of heart disease, renal failure, nephrotic syndrome or obstruction of the retroperitoneal lymph by a tumor. The inspection also allows assessment of secondary sexual characteristics.

'Exploration urological'  Exploration of abdomen.  After a general inspection of the body, usually explore the abdomen for enlarged liver or spleen, palpate the aorta and obtained much information on the nature and content of the abdomen, assessing the presence of hernias or other abnormalities. 'Exploration urological' exploration of kidney  The kidneys are organs with a size similar to the fist, which lie in the retroperitoneum, the back of the abdomen, sides of the spine. Usually the urologist uses his two hands, one in front and other resting on the back, under the ribs, to explore them. Normally not palpable kidneys, except in very thin women and children, so when play gets a kidney, should exclude the presence of renal cysts or tumors. The failure to feel any renal mass does not rule, as in obese or corpulent kidneys are difficult to play.  In newborns, the kidneys can be easily palpated between the forefinger and thumb of your browser. If you notice an increase in kidney size in a newborn, transillumination with a flashlight may allow us to distinguish a cystic lesion with fluid content, a solid lesion or tumor.

Sometimes, auscultation of the abdomen can hear murmurs caused by renal artery disease. The presence of cutaneous hypersensitivity can distinguish between the pain of renal colic and pain that occurs at an early stage of herpes zoster eruption.
'Exploration urological' Exploration of the bladder  The normal bladder can not be felt in the adult unless it contains at least 150 mL of urine. When the bladder is very full, usually because the patient can not urinate, you can get to make visible as a bulge in the lower abdomen. Usually tastes better if the bladder is filled by tapping over the lower abdomen, since normally the sound you get is dull, not hollow as that obtained when the bladder is empty. Sometimes scans are performed bimanual bladder under anesthesia. A hand palpating the abdomen and a finger in the rectum of man or woman's vagina is trying to palpate for bladder tumors or other lesions.

'Exploration urological'  Exploration of the prostate: rectal A rectal examination should be performed every man over 40 who goes to a urology clinic. It can detect potentially curable cancers of both the prostate and rectum. The patient may be lying, standing or kneeling on the couch with his elbows. In college, we prefer the recumbent position, as this is more comfortable for the patient. The urologist places a glove and applies a lubricating gel on the index finger which is then carefully into the rectum. This exploration  allows us to assess anal sphincter tone, if there are hemorrhoids, fissures or fistulas of the anus and feel the prostate for lumps hard (suspected cancer) or floating zone (suspected infection with pus). It also gives an estimate of prostate size. Usually the prospect of submitting to DRE produces fear and anxiety in many patients, both totally unfounded, since it is a painless scan is usually performed in fifteen seconds. When you omit the DRE, we run the risk of failing to diagnose a potentially curable tumor. As urologists say it is better to put the finger blunder. Approximately 25% of patients with suspicious DRE have prostate cancer, and occasionally rectal examination does not detect microscopic cancer foci or small volume. If a nodule is palpable suspicious prostate biopsy should be performed in prostate cancer.

'Exploration urological'  Exploration of the scrotum and testes The scrotum is a limp sack containing the testicles and spermatic cords. The scrotal wall consists of skin and underlying muscle layer. The testes are oval and usually measure about 6 cm long and 4 cm wide. The scrotum has sebaceous glands and hair and is therefore not unusual to see pictures of folliculitis or sebaceous cysts. The testes should be palpated gently with the fingertips of both hands. A hard zone in or on the surface of the testicle should be considered tumor until proven otherwise. However, most external injuries, which affect the epididymis are almost always benign. Transillumination with a flashlight can help to differentiate between a cystic lesion (hydrocele) or solid (tumor). During testicular examination is essential to exclude the presence of inguinal hernias in both lying and standing position. This introduces the finger in the inguinal canal and the patient is asked to cough if it feels the increasing pressure in the inguinal hernia was diagnosed. Testicular cancer is the most common tumor in young men, also increases its frequency from 60 years of age. Usually present as painless nodules, so it should get into the habit of self explore the testicles once a month, and with the suspicion of a lump or hard area in the testicle, the urologist should be consulted quickly. 'Exploration urological' Exploration of the penis  Examination of the penis can assess their anatomy and the presence of skin diseases and other pathological changes. If the patient is uncircumcised, the foreskin should be retracted to examine the glans.  Usually the penis begins by noting the position of the urethral meatus and its size, characteristics of skin and the glans penis and corpora cavernosa are palpated for the presence of induration or plaques. If there are skin changes, as frequently occurs in sexually transmitted diseases, sometimes the mere inspection of the penis is used to establish diagnosis and guide treatment.

What is prostatitis?

What is the prostate gland?

What causes prostatitis?

What is prostatitis treated?

What if my prostatitis is not caused by infection?

Can prostatitis be passed on during sex?

Can prostatitis back?

Should I have my prostate gland taken out if I have prostatitis?

Does prostatitis cause cancer?


URINARY INFECTION. UTI is called every inflammatory process of the urinary organs or their glands attached and which are produced by microorganisms. The causes of this condition is usually bacterial, being more rarely parasites or viruses. The incidence has varied according to sex and age. In the first months of visa is usually more frequent in males serious congenital malformations, in preschool and school children is common in little girls posing as cystitis and pyelonephritis sometimes complicating congenital malformations. Between 20 and 50 years are very often in women, coinciding with the reproductive age and manifests as acute cystitis and chronic pyelonephritis. In the middle-aged man presents a more rare, but if it occurs, is manifested as urethritis and prostatitis. The older man is presented as infections complicating obstructive processes low, especially prostate.

PATHOGENESIS .- It is common infections caused by bacteria that grow well in the usual culture media. The bacteria isolated in urine cultures derived from these processes can be of three types: Urinary tract infection Gram negative rods Urinary tract infection Gram positive cocci Urinary tract infection Gram negative cocci (Neisseria gonorrhoeae) Among the Gram negative strains are the most common E. coli, following the Klebsiella, Aerobacter, Proteus, Pseudomonas aeruginosa and Acinetobacter. Among the Gram-positive cocci can find the Enterococcus, Staph aureus and Streptococcus hemolíticus rarely. According to different statistics, excluding Gonococcus, the frequency of infections with Gram negative bacilli account for 90 to 95% of cases, in our experience. The percentage of coccal infections increased significantly in men because of urethritis and prostatitis, which is also this kind of germs.

The bacteria most frequently isolated in urinary tract infections is Escherichia coli, found in a proportion of 75 to 95% of cases by type of patient. This ratio is more favorable in cystitis and pyelonephritis in the average age of women who consult in general clinics.
In a study of our department of urology in patients who consulted the clinic and those who were hospitalized, the incidence of strains was as follows: Polyclinic Hospitalization Escherichia Coli 78% 59.6% Klebsiella-Aerobacter Proteus Pseudomonas aeruginosa Enterococci Staphylococcus Acinetobacter. In a study in the gynecology service of this facility the percentage of Escherichia coli isolated from urine of patients was 94.8%. This means that the patients consulted urology services with more complicated UTIs. Escherichia coli urinary tract can reach the tree carried by the circulation from a distant focus of infection, this infection has occurred by downward path. If the germs spread to the bladder directly through the urethra, the infection occurred via bottom. Today the latter route is accepted as the most common and has more significance in the pathogenesis of cystitis in women, from bacteria from the vagina to the urethra and bladder.

Associated infections in urological problems which have occurred in diagnostic or therapeutic procedures, the incidence of Escherichia coli decreases relatively in favor of strains of Klebsiella, Proteus, Pseudomonas or other more difficult to manage. This type of infection also occurs via ascending or direct inoculation. These germs are very important as they are difficult to eradicate the resistance it may have to antibiotics, and their ability to mutate its sensitivity. The duality of germs was found in a proportion of 12.9% and may have different association of bacilli or bacilli and cocci. It is also common that an examination of urine culture to another switch microorganisms, and on some occasions, although the same germ persists, it may have different characteristics, especially in their sensitivity to antibiotics. The reason why women are so often presented this pathology is in the anatomical position of the urogenital tract, with a shorter urethra which allows easy ascension of germs. In addition to this sex and pregnancy increase the risk to occur this mechanism of infection. We must also take into account the use of contraceptive devices and spermicides. Is important also in postmenopausal decline of estrogen that act to improve the vitality of the lining of the area, the sclerosis of the vaginal and vulvar mucosa produces increased sensitivity to vaginal and bladder infections. The acidity of the vagina maintained through the lactobacilli, normal bacterial flora also helps to prevent the development of Escherichia coli at this level.

From the point of view of bacteria has been confirmed in recent research about which they are attached to the epithelium through its filaments or fimbriae. These specific antigens that have produced the reaction of cellular defense mechanisms (macrophages) and general (IgA). In this struggle microbiological imbalances are sometimes permit the maintenance of strains in the mucosa with the persistence of pathology. The filaments or fimbriae of Escherichia coli hemolysin and aerobactin produce red blood cells that destroy adjacent tissues and the subsequent host immune response.  Clinical presentation and classification. He described various forms of urinary tract infections, according to the criteria of different authors. According Alken, there are infections parenchymal organs and excretory cavities. Within the first we have pyelonephritis and prostatitis. Within the cavities are infections of cystitis and urethritis. All these can be acute and chronic parenchymal most important are presented with fever and general reaction in the acute forms and sclerosis in the chronicles. Cavity infections, although local reactions are pain, not present with fever in acute processes. Alken continues to define the infection as you turn away anatomic urinary abnormalities in primary or secondary simple or complicated. In the first anatomy revealed by imaging tests are normal in the latter are altered by diseases that cause reactions, such as stones, hydronephrosis, foreign bodies, reflux, tumors, etc ... From the viewpoint of evolution, Stamey are classified in acute, chronic, persistent and reinfection. These last two forms are called recurrent urinary tract infection, because clinically you can not determine if the continuity of the pathology is due to maintaining the focus on the host or other strain is coming from outside (Schaeffer).

Urinary tract infections. The most common clinical form of UTI is acute cystitis usually occurs in women, being in 90% of pure type, ie without higher commitment, according to a study from our clinic (Vargas Z.). The second form is presented as acute pyelonephritis, ie as an acute bacterial inflammation of the renal parenchyma. CLASSIFICATION OF ITU (Alken) Second Primary Urinary tract infection
Fig 1 .- Classification of urinary tract infections as whether or not associated urologic abnormalities. When infection is exacerbated, especially ectasia may occur purulent processes. The most common of these infections is pyonephrosis accompanying hydronephrosis, many as a result of calculations. These severe acute compromise may also occur adjacent tissues to the urinary tract, assuming the form of perinephric abscess, peri-urethral and prostate. Recurrent urinary tract infections. Recurrent infections are characterized by repeated episodes of the same disease process and can pass or not to chronicity. Chronic urinary tract infections. Chronic urinary infection is of great importance for therapeutic problems that often presents. What are the most common chronic pyelonephritis may lead to hypertension and renal failure. The chronic prostatitis are frequent and are manifested by pain, bladder irritation and can lead to sterility. Chronic and recurrent infections can be maintained by general or local factors.

As general factors should be mentioned chronic diseases like diabetes, anemia, hypoproteinemia, cirrhosis, and others that can cause a general organic deficit. There may also be infectious foci distance reinfect the urinary tract, as intestinal sites, teeth, skin or gynecological As local factors, there are the urinary stasis can be caused by mechanical obstruction or neurological (lithiasis, hydronephrosis, neurogenic bladder). Vesicovaginal fistulas, enterourinarias and almost always accompanied vesicocutáneas urinary infections. The intravesical foreign bodies such as equipment arrived by masturbation material operating outcome is so old ... infections remain local cadres. Probes to stay is always accompanied by an infection drained added, especially if not handled with aseptic techniques (urinary tract infection drained). Special importance is given to vesicoureteral reflux, especially in children. These infections can lead reflux from the bladder to the kidneys causing acute and chronic pyelonephritis.

Lyon, Tanager and Bichler have given importance to the urethral meatus stenosis in little girls and adult women as a factor that facilitates the movement of bacteria from the vulva to her bladder and lower urinary tract infections. Would occur at this level bacterial colonization of the distal urethra and hydraulic recoil movements during urination. On many occasions is a set of factors that contribute to the maintenance of these infections.

DIAGNOSIS. This study begins with the patient's medical history and physical examination. Symptoms can be found from a very rich, as in acute pain and / or temperature, and symptoms of bladder irritation (frequency, burning urination, etc ...) or in serious chronic uremia (pyelonephritis with renal failure), until the complete absence of symptoms in latent cases. These latter cases are especially concerned with chronic pyelonephritis, which is often difficult to detect by current diagnostic methods and sometimes is finding pathology. The turbidity of urine means in most cases macroscopic pyuria. However, it should be borne in mind that the precipitation of urate and phosphate salts can produce the same effect. Lab. On suspicion of UTI should be practiced urine aseptically issued. The sample must be taken in second urination in adults and children of both sexes. The sample tube is reserved for special cases. Studying this exhibition, which provides for an examination of the sediment and urine culture to isolate the causative agent, must be done immediately, in case you can not be done, the sample should be kept under refrigeration for several hours.

In the sediment will search for the presence of pus cells, whose presence demonstrates a nonspecific urinary tract infection and tuberculosis in some cases. White blood cells can exist alone or in plates also accompanied by red blood cells. When infectious kidney commitments may occur cylinders granular or hyaline leucocyte. The bacterial species that produce these processes unfold easily in any ordinary culture medium. But not always a positive urine culture is the result of a urinary tract infection. The kidney is an organ that removes bacteria from another location and his finding in the urine may be transient. We must also take into account that the outer portion of the urethra in men and women is provocative source of contamination and false-positive cultures. It is for these reasons that colony counts in urine is of great clinical importance, especially in cases of bacteriuria without pyuria.

Is now recognized that colony counts over 100,000 X cc. urine mean a urinary tract infection safe; accounts col 0 to 10000. x cc. are considered as pollution or bacteriuria; counts from 10,000 to 100,000 col. x cc. are listed as possibilities of infections that must be verified with further tests. The bacteriological examination of urine should be continued with the antibiogram of the isolate because of the great variability of the sensitivities of producing germs urinary infection. This is of great importance for the orientation of the treatment. Blood tests are important in determining changes in hematology, the existence of diabetes, liver or kidney failure. Hence it must be hemogram and biochemical profile and study of creatinine values. All these tests are most important in infectious processes in chronic and recurrent infections. Imaging. For all recurrent urinary tract infections and chronic and acute infections with parenchymal compromise, must be studying renal and pelvic ultrasound in order to seek urological diseases that are complicated by infections. It should examine the possible existence of stones, hydronephrosis, tumors, etc ... If this study is not conclusive pyelography should be complemented with disposal and / or a scanner PieloTac or urinary tract.

TREATMENT. Acute urinary tract infection should be treated with antibiotics or chemotherapeutic agents which act on the bacteria producing it. These drugs generally act successfully, but there are strains of bacteria that sometimes constitute a therapeutic problem due to the resistance of some antibiotics. The variability of strains with different susceptibility, ease of mutation and its tendency to persist in the urinary tract are important factors to consider. That's why to make an efficient treatment is necessary to isolate the germ of urine through the urine culture and study the conditions that favor its multiplication in his urinary tract. Delayed susceptibility usually two days to release the results for which treatment should begin with a broad spectrum antibiotic, or rather with those international and national experience as the most appropriate advice. Below are a table which gives the current sensitivities of different strains to antibiotics commonly used in UTI in our environment: E. Coli Klebsiella Proteus Pseudomonas Chloramphenicol

Most urinary infections are primary or simple with Escherichia coli. In the above table we see that modern antibiotics act in good proportion of this strain. In recent years we have seen that the action of cotrimoxazole and ampicillin, antibiotics of first choice for several years, has deteriorated gradually. We recommend as first choice in urological patients pipemidic acid and norfloxacin due to its action and its lower cost. For more complicated and recurrent infections are advised to start directly with ciprofloxacin or a second-generation cephalosporin. If the infection is with fever and worsening in general you should choose an antibiotic more active and injectors. Concerning the time of antibiotic treatment, pending on the type of infection. Thus in the acute, being the most common acute cystitis, today is preferred treatment for three days, the same time is preferred for gonococcal urethritis. For non-specific urethritis or chlamydial staph treatment must be extended up to 1 week; recommend a mixture of azithromycin with ciprofloxacin or doxycycline). For treatment of acute pyelonephritis should be extended from 7 to 12 days according to the criteria of different authors, should be initiated with ciprofloxacin or cephalosporins, second or third generation, according to the severity of symptoms, if it is important to overall commitment to be chosen intravenous antibiotics. For acute prostatitis, ciprofloxacin is preferred by 12 days and continued with cotrimoxazole to complete 3 to 4 weeks. These two drugs produced a high concentration of prostatic tissue.

In the treatment of chronic or recurrent infections antibiotics were administered in the form of low-dose suppressive or prolonged. The treatment time may be several months. For this purpose nitrofurantoin is used in doses of 100 mg daily, it can also be done with cotrimoxazole or pipemidic acid at low doses. In these chronic or recurrent infections should be resolved urological diseases which are often concomitant, as stones, tumors, hydronephrosis, urethral strictures etc ... Suppurative processes, as piohidronefrosis, or nefronias renal abscess, perirenal and periurethral abscesses must be drained to achieve real control of acute infectious state, and avoiding sepsis. In this sense we can make surgical drains and nephrostomy and cystostomy drainage of purulent collections that have been diagnosed. In cases of suppurative hidroureteronefrosis, due to kidney or ureteral strictures, we had very good results with the installation of dual catheters Jack, as a means of drainage. This procedure has prevented many times you have to perform a surgical nephrostomy. One important way to decrease the incidence of urinary tract infections is prevention. In this sense, must manage a good aseptic technique in the diagnostic and surgical procedures for patients with urological diseases. Special care must be taken in the management of bladder catheterization and treatment of catheter permanence. Bladder catheterization should be performed aseptically and should be handled after the probe to remain closed circuit urinary drainage bag. However, after a week of catheter stay, infection with external contact is inevitable, this indwelling catheter infection is of a type called drained and the patient usually lives with no problems. This situation persists as long as the infection is not particularly exacerbated by management measures without asepsis of the probe is suggested to keep long time suppressive treatment in these cases to minimize this type of infection and prevent exacerbations.


What is Impotence? Impotence is a medical condition